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 Evidence-based medicine: what it can and cannot do Freddi G; Roman-Pumar JLAnn Ist Super Sanita  2011[]; 47 (1): 22-5Evidence-based medicine (EBM) is not a old hat, a "cookbook" medicine perpetrated  by arrogant to serve cost cutters to suppress clinical freedom, a mandatory,  deterministic, totalitarian practice of medicine, a way to control cost and to  ignore patient preferences, a limit to personal/ humanistic/individual medicine.  EBM is a reference of excellence to guide clinical decisions, the integration of  own expertise with others' expertise and patient preferences, a way to improve  medical practice and limit the variability and errors created when there is not  evidence to identify the gold standard and differentiate among alternatives  available. But evidences need to be integrated with a new thinking based on  Complexity Science. Health care systems operates as complex adaptative systems  rather than rigid, linear or mechanical organizations and innovation is a  critical outcome of Complexity Science. How does EBM impact drug innovation? New  drug approvals are not keeping pace with rising Research and Development  spending, clinical approval success rate for new chemical entities (NCEs) is  progressively dropping and maybe, through these indicators, we are seeing the  worst face of EBM: its limiting, blocking, and controlling side. If that is the  case, EBM is the main ally to keep the economy of health systems under control  and the great excuse to block the access of the innovation to patients. Certainly  not the best way to maximize the benefits of EBM.|Delivery of Health Care/organization & administration[MESH]|Diffusion of Innovation[MESH]|Evidence-Based Medicine/history/*trends[MESH]|History, 21st Century[MESH]|Holistic Health[MESH]|Humans[MESH]|Research[MESH]
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